Black Patients Are Less Likely to Receive Opioids for Back Pain, Abdominal Pain, But Not for “Definitive” Pain
BY JEFF BAUER
FROM PLOS ONE
Black patients who present to the ED with back pain or abdominal pain are significantly less likely to be treated with or prescribed an opioid than are white patients who report similar pain, according to an analysis of data on national ED visits. However, there were no differences in opioid use among black patients and white patients for more objective pain conditions, such as kidney stones or long bone fractures.
Researchers evaluated National Hospital Ambulatory Medical Care Survey data that included descriptions of ED visits made by adults ages 18 to 65 years from 2007 to 2011. They looked specifically at pain-related visits, and defined the reason for each visit as being a “nondefinitive condition” (toothache, back pain, or abdominal pain) or a “definitive condition” (long bone fractures or kidney stones). These nondefinitive conditions have been associated with drug-seeking behavior.
The subjects were categorized as non-Hispanic white, non-Hispanic black, Hispanic, or non-Hispanic other. Pain was rated on a scale from 0 (no pain) to 10 (severe). Researchers also measured whether the patients received an opioid while they were in the ED, were discharged with a prescription for an opioid, or both.
During the study period, there were approximately 36.5 million ED visits for abdominal pain, 14.3 visits for back pain, 6.9 million visits for toothache, 3.4 million visits for kidney stones, and 2.1 million visits for long bone fractures. For each of these conditions, most visits were associated with severe pain.
After adjusting for pain severity, non-Hispanic black patients with abdominal pain or back pain were significantly less likely than their white counterparts to be administered an opioid while in the ED or to be discharged with a prescription for an opioid. However, there was no significant difference between these groups in opioid administration or prescription for patients with long bone fractures, kidney stones, or toothache. Researchers suggested that although toothache was considered a nondefinitive condition in this study, physicians might have been able to verify dental disease during examination of the mouth, thus limiting the subjectivity in their decision to prescribe an opioid.
1. Singhal A, Tien YY, Hsia RY. Racial-ethnic disparities in opioid prescriptions at emergency department visits for conditions commonly associated with prescription drug abuse. PLoS One. 2016;11(8):e0159224. doi: 10.1371/journal.pone.0159224.
FDA Updates Warning Label for Systemic Fluoroquinolones
BY DEEPAK CHITNIS
FRONTLINE MEDICAL NEWS
The Food and Drug Administration (FDA) has amended the boxed warning on labels for fluoroquinolone antibiotics, taken either orally or by injection, to reflect recent findings of the drugs’ potential adverse events.
“These medicines are associated with disabling and potentially permanent side effects of the tendons, muscles, joints, nerves, and central nervous system that can occur together in the same patient,” the FDA stated in its Safety Announcement.
As a result, health care providers should reserve systemic fluoroquinolones for patients who have no other treatment options for any of the following conditions: acute bacterial sinusitis (ABS), acute bacterial exacerbation of chronic bronchitis (ABECB), and uncomplicated urinary tract infections (UTIs). The FDA also said that for some serious bacterial infections, the benefits of fluoroquinolones outweigh the risks, and it is appropriate for them to remain available as a therapeutic option.
Patients taking fluoroquinolones must also be vigilant and let their provider know immediately if they begin suffering from any new pain in their joints, tendons, or muscles. Additionally, if patients begin feeling any numbness in their arms and legs, a prickling or “pins and needles” sensation, or confusion and hallucinations, they should contact their health care provider right away so that they may be switched to a nonfluoroquinolone antibacterial drug for the remainder of their treatment regimen.
Avelox (Moxifloxacin); Cipro, both standard and extended release (ciprofloxacin); Factive (gemifloxacin); Levaquin (levofloxacin); and ofloxacin are the fluoroquinolones currently approved by the FDA for systemic use.
Additional adverse effects for patients taking fluoroquinolones could include tendinitis, tendon rupture, and joint swelling. Central nervous system afflictions could include depression and thoughts of suicide. Fluoroquinolones could also bring about skin rashes, sunburn, arrhythmia, and diarrhea, and could aggravate myasthenia gravis in patients who suffer from it. Warnings regarding these conditions are already included on the drugs’ existing boxed warning.
“In addition to updating information in the Boxed Warning, we are also including information about these safety issues in the Warnings and Precautions section of the label,” the FDA stated. “The Indications and Usage section contains new limitation-of-use statements to reserve fluoroquinolones for patients who do not have other available treatment options for ABS, ABECB, and uncomplicated UTIs.”